A Novel Role of Protein S in Blood Coagulation Protein S (PS) is an important anticoagulant, deficiencies of which are one of several known risk factors for thrombophilia and increased risk of blood clots such as Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). In severe cases of PS deficiency, soon after birth infants develop a life-threatening blood clotting disorder called purpura fulminans. However, despite 30 years of study of this important anticoagulant, the exact function of PS is still unknown. Protein S was initially characterized as a cofactor of activated protein C (APC), but PS confers only a modest increase in APC activity. Plasma assays in the absence of APC suggested other important, APC-independent roles of PS. Some reports suggest that PS inhibits prothrombin activation to thrombin, but the validity of those reports has been questioned because of artifacts due to PS multimerization. In 2006, it was shown that PS acts as a cofactor of tissue factor pathway inhibitor (TFPI) in the initiation of coagulation. Our recent work has shown that PS inhibits factor IX (FIXa); importantly, we used conditions, e.g., high concentrations of phospholipid vesicles that avoid artifacts from PS multimers. Our goal is to mechanistically define both the physiologically relevant function of PS and the specificity of PS inhibition of FIXa. We will use a multifaceted approach to identify the regulatory role of PS. Our proposal involves detailed in vitro, ex vivo and in vivo studies to establish that protein S inhibition of FXa is specific and physiologically important. This proposal consists of two aims: 1) Determine the contact regions between FIX and PS and 2) establish the physiological significance and specificity of protein S inhibition of FIX. Successful completion of our proposal will sharply defie a novel regulatory role of PS that operates independently of APC and TFPI. The knowledge we acquire of the mechanism of this novel regulatory function will enable future development of new therapeutics designed to target the contact point between FIX and PS. Also, inhibitors of PS activity will form the basis of an adjunct therapy for hemophilia, and, by inhibiting hyper- functional FIX, PS could be used in the treatment of X-linked thrombophilia.